Build It and They Will Come: Can Technology Change Behavior?

Murrey G. Olmsted, Ph.D., BreathEasy Senior Methodological Advisor, RTI International

I recently heard a story on the news about the famed “Field of Dreams” farm in Dyersville, Iowa. This story reminded me of the approach taken with personal health records (PHRs) and health tracking devices over the past decade. Well intentioned clinicians, researchers, technologists, and others have brought many products to the market and have assumed that if you build a new device or PHR then people will use it to improve their health. As a result, we now have electronic devices that track steps taken, food consumed, water drunk, hours slept, and many other indicators of health and health-promoting behaviors. Now even our smartphones can provide many of these functions via apps that take advantage of motion sensors, GPS tracking, photo uploading, social networking, and barcode scanning. One common feature that most of these tools share is that they are tied to a record system such as a diary, tracking log, or PHR.

This all sounds great! More technology to enhance health that is portable, easy to use, and probably works on the smartphone I already have. If I were only to read the promotional literature, I might be convinced we are heading toward a golden age of health improvement with technology leading the way.

However, there is some trouble in the world of PHRs and health-promoting technologies:

• First, the annual CDC reports indicate that on average people are still significantly overweight, developing diabetes at alarming rates, and struggling with many chronic health conditions.
• Second, most devices or record systems don’t talk to each other. For instance, my smartphone tracks walking and running data on a website provided by a major sports manufacturer. The record is great in terms of helping me track my activity and communicate with my friends, but it does not connect to my own physician’s clinical electronic health record (EHR) or any other system that I have.
• Third, the PHR used at my doctor’s office provides tools for tracking my historical health data, but does not provide any help on what steps I need to take to enhance my health going forward; this is a common problem with PHRs, as most serve only as patient information portals rather than offering the full functionality needed.
• Fourth, the options for consumer-oriented PHRs are declining. For instance, Google Health announced earlier this year that they would be shutting down their PHR service at end of 2011 due to the lack of broad consumer adoption. As a result, I now have to choose between the PHR offered by my doctor or one of the few remaining national PHRs still available (e.g., Microsoft HealthVault, WebMD PHR, etc.).

So what’s the problem? I thought we had the technology? 

It turns out—not surprisingly—that behavior is difficult to change. Technology is great and people generally enjoy using it, but the impact is frequently not long-lasting unless fundamental behavior change occurs. To do that, the current crop of technological solutions will need to address not only the challenges listed above (in particular connecting all patient records), but will also need to help users change their behaviors. Published research is increasingly citing the need for behavior change as a key component of health-promoting technology. Also, authors are beginning to draw the distinction between PHRs that function as health information banks (e.g., look-up systems for lab results) and those that are truly ‘personal’ which can be customized to the needs of the user. What is really needed are tools that can serve the specific needs of users by guiding and encouraging them along in their journey toward behavior change, not just simply track their data and hold it for safekeeping. If the technology can make this shift, then we may start to see better results in those annual CDC reports.

Let us know what you think: How is behavior change key to successful health technology development and use?

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Comments

[Mace Horoff]

Great point about the difficulty in changing behavior. Most HCP's understand the benefits of PHR's, but it takes motivating them at a deeply personal level to get them to change their habits. I've watched doctors make the switch to EMRs and if they don't go into it knowing that it's going to get worse before it gets better, but once they make it through the learning curve, they would never go back to paper records.
Mace Horoff